Emergency Medical Form

Be prepared for a worst-case scenario using our emergency medical form, and quickly provide front-line workers the information they need to save crucial time in an emergency.

By Harriet Murray on Feb 27, 2024.

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What Is An Emergency Medical Form

Have you ever thought about what would happen if someone in your care had a medical emergency? Whether it’s an employee, a client, a student, or a child you’re looking after- in an emergency, they may not be able to convey crucial medical information themselves. Luckily, we can prepare for the worst-case scenarios, and even though we hopefully never have to use it, our is designed to give you peace of mind that in an emergency situation, you’ll be able to quickly access the information medical staff may need.

An emergency medical form is a document containing any relevant information for a medical emergency, such as current medications, medical conditions, or emergency contacts. Time is of the essence in an emergency, so having an emergency medical form already filled out and accessible for anyone who may need it is a great way to save crucial minutes and maximize the possibility of a good outcome for the patient.

Our emergency medical form includes spaces for personal information, medical conditions and current medications, allergies, emergency contacts, and an emergency medical authorization either for an adult or child patient.

Printable Emergency Medical Form

Download these templates for emergency medical forms to improve your therapy intake process and HIPAA compliance.

How To Use This Template For Emergency Medical Form

We’ve kept this emergency medical form template short and sweet so anyone using it in an emergency doesn’t have to search through multiple pages. Everything that needs to be filled in is on a single page, so once you’ve downloaded the free PDF from the link on this page, let’s go through the different steps to filling in this form.

Step One: Personal Information

The first section is for identifying information such as your name, address, and date of birth. This information can be useful for finding your medical records at an emergency department, all of which will save crucial time in an emergency.

Step Two: Emergency Contact Details

Your emergency contact is the person who will be phoned if you have a medical emergency. You may want to choose someone who lives nearby, or someone who you know is likely to be contactable during an emergency. Add their name, phone number, and relationship to you.

Step Three: Medical Information

Next, fill in the medical information section, including any medical conditions you have, current medications, allergies, and any additional information that could be helpful in an emergency situation.

Step Four: Emergency Medical Consent

The emergency medical consent authorizes someone else to authorize medical care for yourself or someone in your care in the event of an emergency. Add your name, the name of the person or company you are authorizing, and the name of the person to who you are consenting on their behalf. If you are consenting to emergency medical treatment for your child or another dependent person, fill in the parent or guardian name and relationship to the patient section. If not, just leave these sections blank. 

Step Five: Store somewhere safe and accessible.

The last step is to store this form somewhere secure and accessible in an emergency. If you are having your employees or students fill this form out, keep it stored physically or digitally along with their other important information.

Emergency Medical Form Example (Sample)

To get a better idea of how to use this emergency medical form, and how it can be useful in a medical emergency situation, take a look at our example below. You can download the free interactive template from the link on this page, or download the example emergency medical form as a PDF to take a closer look.

Download this Emergency Medical Example (Sample) here: 

Emergency Medical Form Example (Sample)

Who Can Use this Printable Emergency Medical Form (PDF)?

This emergency medical form is super versatile for use across all different fields. Take a look at just some of the use cases for this handy form.

Emergency department physicians and nurses

Perhaps the most obvious choice of user for an emergency medical form is the people who see emergencies every day, that is, doctors, nurses, paramedics, or other clinical staff who work in emergency departments. By having an emergency medical form already filled out, you ensure these front-line workers who will be the first to arrive on the scene of the emergency have the information they need to make life-saving decisions. 

Schools, daycares, or kindergartens

Once a child’s parent drops them off for the day, are you confident you’d have the information you need if their child has a medical emergency? Our emergency medical form is ideal for use by schools, daycare facilities, kindergartens, or any institution that involves looking after minors.

Employers

If your employee were to have a medical emergency, ensure you are prepared with their medical information. Our emergency medical form makes a great addition to a new employee’s induction documentation and will give you and your employees peace of mind that their life-saving information is accessible if ever it is needed. 

Assisted living or aged care facilities

The elderly may be taking several medications, or have had certain medical treatments or conditions, that will change the way they need to be treated if they are to have an emergency. Ensuring this information is stored in writing and accessible when it is needed will help you to offer the best possible care for your residents. 

Nannies or babysitters

Even if it’s just for the odd night here and there, ensure you are prepared for the worst-case scenario. By having your clients fill in an emergency medical information form for the children you are looking after, you can demonstrate your initiative and capability for the service you are providing.

Why Is This Form Useful For Physicians

This form gives physicians the information they need to make informed clinical decisions on their patient’s behalf. In an emergency, the patient may be unconscious or physically unable to convey the information they need. As such, being prepared with completed emergency medical information is a fantastic idea as in an emergency- every second spent trying to gather information could count toward whether someone survives an emergency situation.

Our emergency medical form provides physicians with your current medications, any existing medical conditions, emergency contact details, and allergies. All of this important information may prove crucial in an emergency.

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Why Use Carepatron For Emergency Medical Form?

As we mentioned before, keeping your emergency medical information stored digitally can be a great way to go, but you’ll also need to ensure the form is stored securely as it will contain sensitive and confidential medical information. That’s where Carepatron comes in. We offer bank-level encryption and HIPAA-compliant data storage which you can easily access from our mobile or desktop platform. 

In addition to security, Carepatron also offers a whole suite of practice management tools including a client list, appointment scheduling, and video appointment functionality, medical coding and billing management, and, in addition to our emergency medical form, hundreds of forms, templates, and worksheets designed to standardize your practice and save you time. 

Find out why 10,000+ medical practitioners, social workers, psychologists, and more have chosen Carepatron to elevate their practice to the next level.

Emergency Medical Form Software
What is an emergency contact?
What is an emergency contact?

Commonly asked questions

What is an emergency contact?

Your emergency contact should be someone that can be phoned in the event that you have a medical emergency. This should be someone who is generally contactable, and who has a close relationship with you, such as a parent, spouse, or close friend.

Who should I give the emergency medical form to?

If you are managing the storage of emergency medical information forms, don’t delay and offer the medical information to the first responders at the medical emergency or the doctors at the emergency department. In an emergency situation, it’s better to offer information than to hold it back thinking it won’t be relevant.

Who needs an emergency medical information form?

Anyone could have an emergency medical form, as it is always useful to know current medications, allergies, or medical conditions. However, if you have a known medical condition that could potentially lead to you having a medical emergency, such as severe allergies, diabetes, epilepsy, or a history of strokes or heart disease, it is definitely a good idea to note this information for your employer, housemates, or anyone else who may need to assist in an emergency.

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